Cuomo's plan puts home health care in peril

By Joanne Cunningham

Published 12:10 am, Monday, March 21, 2011

With a crush of $1 billion in cuts, unfunded wage mandates and threats to existing care-management models, Gov. Andrew Cuomo's Medicaid budget plan has the potential to dissolve New York's home care system as we know it.

Cost or utilization caps and cuts applicable to all Medicaid services are enough to damage major parts of New York's home care infrastructure at a time when 70 percent of home care providers are operating in the red, because of past state budget actions. But that's where the similarities to other Medicaid services end.

Having no voice on the state's Medicaid Redesign Team -- the panel of health care "stakeholders" tasked with vetting Medicaid proposals -- home care providers statewide are getting slammed with 36 percent of the fiscal impact under this Medicaid budget, even though home care is just 12 percent of Medicaid.

In addition to across-the-board fiscal impacts, home care, unlike other sectors, is getting hit with its own brand of damaging rate reductions, reimbursement system changes, a wholesale gutting of its existing care-management infrastructure and a plan for unprecedented state government intrusion into home care operations through an unfunded home care wage and contracting mandate.

The political equation is simple: Achieve most of your Medicaid reductions by inflicting the worst damage on stakeholders left out of the process.

To justify its disproportionate assault on home care, the administration has repeatedly given voice to misleading data about home care spending while largely ignoring the Home Care Association of New York State's proposals for assisting in more precise authorization of home care services to reduce costs.

HCA's proposals would incentivize providers to be more efficient through payment reforms, eliminate administrative inefficiencies that waste Medicaid resources and create new mechanisms to make sure that patients receive care when they need it, avoiding higher cost care in institutions like nursing homes and hospitals.

Using conservative estimates, HCA has calculated that enforcement of nursing home diversion laws would reduce admissions. Moving just 10 percent of nursing home patients to a community-based model like the state's Long Term Home Health Care Program translates to $150 million in savings.

Instead, the governor's $1 billion blow to home care will mean that successful, cost-effective home care models will fold, including agencies that have served their communities for decades. Chronically ill, elderly and disabled New Yorkers will spend more time in hospitals, nursing homes and institutions. Medicaid costs will increase; and the entire health care system will suffer.

It is up to the Legislature to reject this assault on home care, for the good of vulnerable New Yorkers and the health care system as a whole.